HEMODYNAMIC-EFFECTS OF WATER IMMERSION IN SEVERE BURN PATIENTS

Repeated water immersion is currently used in France in the treatment of severe burn injury. A prospective study was carried out to assess the haemodynamic effects of immersing such patients in a half sitting position in water, the temperature of which was kept at 35-degrees-C. The burn exceeded 50 % of body surface area (BSA), with at least 30 % being third degree burns. The study was carried out during thc first bath, three days after the injury. The patients were immersed up to the clavicles. They were sedated with 2 mg . h-1 of both flunitrazepam and phenoperidine, and were mechanically ventilated. The following haemodynamic parameters were monitored : heart rate, arterial blood pressure (the transducer being level with the arterial catheter), right atrial and pulmonary arterial pressures (the transducer being level with the right atrium, level which had been marked on the chest before immersion and placed two intercostal spaces higher after immersion because of the change in position of the heart). The cardiac output was measured using the thermodilution method. The patient's temperature was monitored with the thermistance of the Swan-Ganz catheter. Values were obtained before immersion. after 15 and 30 minutes of immersion, and 5 minutes after the end of the bath. Nine patients were included, 2 women and 7 men, aged between 24 and 45 years, weighing 73.7 kg on average. Burn size was 78 % of BSA (range 64 to 95 %). Water immersion was maintained for 34 +/- 3 min. The right atrial, mean pulmonary arterial, and wedge pressures, and the cardiac and systolic indices increased. On the other hand, heart rate, mean arterial pressure, systemic vascular resistances and body temperature did not change significantly. These changes were similar to those described in healthy volunteers or in patients anaesthetised for extracorporeal lithotripsy. All the parameters had returned to preimmersion values 5 minutes after the end of the bath. These haemodynamic variations could jeopardize the cardiac and circulatory state of patients with a history of cardiac disease or in whom the burn and the infection with which it is often associated decrease cardiac and circulatory performances.